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Is Twitter Safe & Effective?,[object Object],66,[object Object],Ominous Predictions ,[object Object],About Twitter:,[object Object],Dangers of the Real-time Web in Healthcare,[object Object],by Phil Baumann, RN BSN,[object Object],@PhilBaumann,[object Object],Is Twitter Safe & Effective?,[object Object],[This ebook is a repurposing of an original blog post 66 Ominous Prediction About Twitter in Healthcare published on September 9, 2008.],[object Object],Is Twitter safe and effective?,[object Object],Several years ago, as a second-career registered nurse practicing critical care - having a prior background in enterprise working with fairly sophisticated information technologies - it was all too easy for me get frustrated with paper medical records and laboratory reports laying in floors drenched in Clostridium difficile.,[object Object],How was it possible in the 21st Century that the informational flows in healthcare facilities could end up on contaminated floors? Surely, I thought, there must be technologies within our grasp that could spare us - our patients and the staff - such dangerous indignities.,[object Object],I can't remember where I was when I first heard of Twitter, but I was one of its early adopters. It occurred to me that Twitter's essential feature - the power to share data instantly and briefly - was worthy of consideration in health care. But my early ideas about invoking Twitter into healthcare faced two hurdles: HIPAA always got in the way of my thinking and nobody else I knew at the time ever heard of "
a Twitter"
.,[object Object],After Twitter deleted my first account, I gave up on the incompetent service. When I returned to Twitter sometime in early 2008, the use of Twitter (or any other social medium for that matter) in healthcare was still relatively unheard of.,[object Object],Part of the reason I started blogging was to fill a relatively empty void in the healthcare social media space. Today, I believe we are seeing that space filling with more important voices. Since publishing 140 Healthcare Uses of Twitter in January, hundreds of hospitals have started up Twitter accounts. Every day we hear about Twitter's role in health care, from disaster management tosurgical live-tweeting.,[object Object],So far, the word is largely positive concerning the experiences of a relatively small number of hospitals on Twitter. But has Twitter gone through the strainer, the one beyond the marketing and PR uses? I'm not so sure but I'm hopeful. Time and the further adoption of the service will tell us more about its safety and effectiveness.,[object Object],BETWEEN EVANGELISM AND DEVIL'S ADVOCACY,[object Object],A purpose of the list I published in January was to start a discussion about how micro-messaging technologies like Twitter could be used in health care. Twitter's fame and hype continue to skyrocket and health care is one of the hottest topics of our time. I have no doubt now that micro-messaging and health care are important partners. My task then was to be an evangelist in a time of sparse awareness. The questions now are how far we will go with these technologies and what kinds of challenges and fears we are willing to face and overcome.,[object Object],For as much as Twitter is now being examined by the healthcare and pharmaceutical industries (a welcomed step), we have yet to flesh out practical opportunities and dangers Twitter poses for them. I am encouraged that hospitals are tweeting. Some are doing remarkable work and learning as they proceed. But I also have concerns about the incorporation of Twitter in the healthcare setting. I know all too well about Twitter's seductions. Twitter makes almost everything easy, including regret.,[object Object],I have therefore assembled a collection of dark predictions about how Twitter may be misused or misappropriated. My task now is to be Devil's advocate during a time of attention obesity.,[object Object],I don't know if I saved Follow Friday. I do hope that in the rush to embed Twitter into our daily lives that we strike the right chords between Twitter Evangelism and Devil's Advocacy.,[object Object],66 Ominous Predictions About Twitter,[object Object],[object Object]
Your Direct Message will FAIL. Horribly.
Your organization/practice will violate HIPAA. Repeatedly.
Patients who don’t fully understand Twitter’s viral powers will find themselves woefully embarrassed.
Your surgeon will tweet the wrong body part.
Disaster management will be a disaster thanks to spam.
Pandemic alerting will be a mess thanks to spam, panicked retweets, amateur microbiology and the Baumann Uncertainty Principle.
Twitter will never reserve hashtags for sole use by the CDC or FDA or any other public service to guard against spam and keep channels of authority open.
Big Pharma will pay out tens of billions of dollars in fines and civil lawsuits related to alleged misleading statements in the course of tweet-marketing.
Pharmaceutical company Twitter accounts will be hacked and the exploits will tweet misleading drug information, malicious links, confidential legal settlements and other embarrassing material.
Twitter’s curious effects on Dopamine will lead to addictive behaviors interfering with activities of daily living.
Healthcare marketers will revert to the traditional broadcast model of marketing after realizing quarterly earnings aren’t immediately boosted by providing free value to the communities they serve.
Twitter will accelerate the proliferation of self-diagnoses.
Insurance companies will find and track patients by viewing the follow lists of public-timeline hospital Twitter accounts.
Insurance companies will set up dashboards to monitor insureds and use the information profitably.
Twitter chats about healthcare reform will be infiltrated by Townhall-like Hashtagging.
Patient dignity will be violated by nurses and doctors who tweet about their shifts-from-hell.

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66 Ominous Predictions About Twitter In Healthcare

  • 1.
  • 2. Your Direct Message will FAIL. Horribly.
  • 3. Your organization/practice will violate HIPAA. Repeatedly.
  • 4. Patients who don’t fully understand Twitter’s viral powers will find themselves woefully embarrassed.
  • 5. Your surgeon will tweet the wrong body part.
  • 6. Disaster management will be a disaster thanks to spam.
  • 7. Pandemic alerting will be a mess thanks to spam, panicked retweets, amateur microbiology and the Baumann Uncertainty Principle.
  • 8. Twitter will never reserve hashtags for sole use by the CDC or FDA or any other public service to guard against spam and keep channels of authority open.
  • 9. Big Pharma will pay out tens of billions of dollars in fines and civil lawsuits related to alleged misleading statements in the course of tweet-marketing.
  • 10. Pharmaceutical company Twitter accounts will be hacked and the exploits will tweet misleading drug information, malicious links, confidential legal settlements and other embarrassing material.
  • 11. Twitter’s curious effects on Dopamine will lead to addictive behaviors interfering with activities of daily living.
  • 12. Healthcare marketers will revert to the traditional broadcast model of marketing after realizing quarterly earnings aren’t immediately boosted by providing free value to the communities they serve.
  • 13. Twitter will accelerate the proliferation of self-diagnoses.
  • 14. Insurance companies will find and track patients by viewing the follow lists of public-timeline hospital Twitter accounts.
  • 15. Insurance companies will set up dashboards to monitor insureds and use the information profitably.
  • 16. Twitter chats about healthcare reform will be infiltrated by Townhall-like Hashtagging.
  • 17. Patient dignity will be violated by nurses and doctors who tweet about their shifts-from-hell.
  • 18. Big Pharma and medical device companies will pay out tens of billions of dollars in fines (again) years after the FDA decides what regulatory rules to impose on tweeting.
  • 19. Lawyers will set up dashboards to monitor the tweets of pharmaceutical companies, device manufacturers, doctors and healthcare organizations in search of sweet opportunities.
  • 20. Big Pharma will find itself finally engaging with patients on Twitter, only to realize that having 1,550,000 followers on Twitter means having to employ armies of drug safety associates 24/7/365.
  • 21. Twitter chats around specific disease processes will be polluted not only with spam but also misinformation masquerading as evidenced-based medicine.
  • 22. Patient-provider boundaries will be broken at alarming rates.
  • 23. A patient with depression will enter an unstoppable cycle: depressing tweets which lead lead to being un-followed and ignored, leading in turn to more depressing tweets…
  • 24. During a live-tweeted procedure that goes wrong, staff will forget to personally attend and inform the family reading the tweets.
  • 25. Privacy settings in Twitter will be reset to public, either by a Twitter glitch or hack or user-error and patient data will be inadvertently published.
  • 26. Psychotherapists using Twitter to communicate with patients will misinterpret or miss a patient’s tweet, resulting in a suicide.
  • 27. Hospital staff will tweet out information related to an incident.
  • 28. The overuse of Twitter will increase hypomania in patients with bipolar affective disorder.
  • 29. Obesity will continue to proliferate as healthcare consumers spend more time on Twitter looking for diet and exercise tips.
  • 30. Tweeters expressing suicidal ideation will be trolled by malicious malcontents.
  • 31. The wrong kind of medical crowdsourcing will led t the wrong diagnostic judgements.
  • 32. Nurses who are not accustomed to the safe use of clinical micro-messaging will be distracted from their bedside duties.
  • 33. Doctors in facilities that employ enterprise micro-blogs may issue the right order to the wrong patient.
  • 34. The wrong laboratory results will be mis-tweeted. Fortunately, a smart nurse will notice the discrepancy between the lab value and the patient’s signs. This time.
  • 35. Patient timelines in facilities using micro-sharing technologies will be confused, causing all sort of mayhem during shifts.
  • 36. The tweets of doctors will be used in courts to contradict testimony regarding timeline claims.
  • 37. The content of doctors’ tweets will be compiled and analyzed to challenge their competencies.
  • 38. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end.
  • 39. Nurses will lose their jobs for posting TwitPics of patients in undignified positions.
  • 40. Family members will stick their unsolicited noses in each others’ health matters.
  • 41. CDC will inadvertently create panic during a major outbreak after a single malformed tweet is retweeted relentlessly. CNN and Fox News, confusing Twitter with sourcing, will re-broadcast the tweet, fueling more retweets and distortions of the original tweet.
  • 42. Small practices using Twitter for scheduling will tweet the wrong patient or time.
  • 43. Hospitals will monitor their staff’s Twitter streams for violations of confidentiality and other reasons for discipline or termination.
  • 44. Hospitals who don’t understand the subtle dynamics of Twitter-sociology will find themselves in front of public relations nightmares.
  • 45. Healthcare information consumers will be under-served by over-reliance on 140 characters, especially by organizations that don’t have a well-rounded social presence on the web.
  • 46. Hospital administrators will tweet annoying requests to staff busy with more important tasks.
  • 47. In a maternity ward, somewhere in the Midwest, the grandparents of twelve girls will read a tweet saying “It’s a boy!”, only to find out someone saw something that wasn’t there.
  • 48. A drug guide application accessible via Twitter’s API will return links to outdated content.
  • 49. Shortly after retweeting the funniest thing she ever read, a newlywed will find out about her husband’s STD.
  • 50. Pharma will receive an unprecedented volume of Warning Letters for its uses of Twitter.
  • 51. A pharmaceutical company will inadvertently issue a drug safety alert about the wrong drug, resulting in billions of dollars in lost sales with a single tweet.
  • 52. A pharmaceutical company will not issue a drug safety alert, resulting in one of the largest class action suits in history since the failure will be retweeted.
  • 53. The FDA will issue a drug safety alert about the wrong drug, resulting in billions of dollars in lost sales with a single tweet.
  • 54. Practices using Twitter for patient care reminders will mix up patient Twitter accounts, causing confused home-care.
  • 55. A psychiatrist being sued for breech of confidentiality on Twitter will be relieved when she discovers that Twitter’s search engine no longer returns her troublesome tweet. Unfortunately for her, the lawyer suing her will find the tweet onFriendFeed’s search.
  • 56. Hospitals who should be blogging or otherwise investing in a larger social media landscape will over-invest in Twitter, since everybody has Dopamine receptors (see #11).
  • 57. Segments of the health care population who aren’t using Twitter will be overlooked or under-served.
  • 58. Allied care coordination, will be hampered by confusing tweets.
  • 59. Patients will increasingly realize that they can tweet adverse events on Twitter. 4Chan will catch on to this too. The big heart of a near-retirement CEO in Big Pharma will enter ventricular fibrillation. He will survive and will be prescribed the medication fictively referred to in #52.
  • 60. David will become internet famous during the next major infectious outbreak. The public, unaware of @CDCemergency, will go to the most logical Twitter name for CDC: @CDC. The confusion will lead to the conclusion that CDC is not on Twitter and will turn to bogus accounts and spammed hashtags for updates. This oversight by CDC and Twitter will go down as one of the biggest failures to capitalize on brand equity.
  • 61. The FDA will finally issue guidance allowing pharmaceutical companies to tweet links to products. Curiously, the FDA will encourage those tweets to be “non-retweetable”, stating that it will use its discretion in fining companies $10,000 for each retweet if, in the FDA’s opinion, the tweet appears “overtly re-tweetable”.
  • 62. The FDA will allow healthcare applications to be built on Twitter’s API. What’s more, the FDA, in its recognition of the importance of real-time technologies in our daily lives, will outline an efficient seven-year approval process for each application.
  • 63. Remarkable healthcare applications will be build on top of Twitter’s API, spurring wider acceptance of twitter in serving the health care needs of the public. Unfortunately, Twitter will make unannounced changes in its API. Jesse Stay, having helped to develop one of the most downloaded Diabetes iPhone apps, will suffer a brain aneurysm while discussing the changes with Twitter. He will survive and recover but will go on to delete his Twitter account and give up application development.
  • 64. The FDA, realizing Twitter’s role in public health, will require pharmaceutical companies and device manufacturers to publicly tweet Serious Adverse Eventswithin 24 hours of receipt of notification. The hypothetical executive referred to in #59, in an extraordinary episode of psychosis, will go postal and use Twitter to live-tweet his rage. From that day onward, the phrase “going postal” will be replaced by “going Twitter”.
  • 65. HIPAA will be repealed and replaced with the Health Insurance Tweetability and Liability for Electronic Records Act of 2010. Among the provisions is the requirement that hospitals with public Twitter profiles not display their Following and Followers on their accounts. Twitter, of course, will offer no way to do this.
  • 66.